MATE

MATE Summary for Health Professionals

Despite continual advances in cancer research the scale and consistency of unjustified variation in cancer management which is observed across different healthcare systems is astonishing. In the United Kingdom, the Calman-Hine report published in 1995 was the first major government undertaking to acknowledge large unwarranted variations in cancer diagnosis, work-up and treatments within the National Health Service. The report recommended several measures to tackle the problem, of which the most important one was the adoption of the Multi Disciplinary Team (MDT) model for cancer care. The National Cancer Plan published by the UK government in 2000, endorsed MDT meetings as a key forum for implementing the MDT model. These meetings bring together medical, radiation, and surgical oncologists, pathologists, physicians, radiologists and allied health practitioners, with the aim of combining the expertise from each field to generate a comprehensive and coordinated care plan for patients.

Unfortunately, more than a decade after its initial implementation, the full potential of cancer MDTs remains largely unrealised. Little evidence has been collected to justify the claimed benefits of the MDT model. The theoretical assumption that the MDT would ensure high-quality, evidence-based decision making, optimum treatment planning and delivery of care, remains untested and unsupported by data. Many recently published studies have specifically raised concerns over the lack of evidence about the benefits of cancer MDTs given the time and resources that MDTs require. A large national survey of more than 2000 cancer MDT members was recently conducted in the United Kingdom and the majority of respondents stressed the urgent need to support this crucial but overburdened forum for decision-making.

The broad hypotheses of our research are that if the cancer MDT is provided with a practical and flexible decision support platform, capable of capturing diverse evidence formats, integrating the evidence into decision-making in a patient-specific way and respecting the MDT’s autonomy, then the quality of MDT decisions will be improved and more consistent, transparent, evidence-based care will be delivered to cancer patients. A novel computerised decision support system called MATE has been developed to address these challenges. MATE is based on PROforma technology pioneered at Cancer Research UK.

The initial results of MATE are very promising. We have collected data on more than 1,000 breast cases presented at the breast MDT meetings in the Royal Free Hospital. The MATE system was able to suggest treatment recommendations in concordance with evidence-based guidelines in 98% of the cases. MATE also identified 38% more patients suitable for recruitment into ongoing national and regional research trials.

We believe that deviations that occur in unaided MDT meetings can be minimized using MATE. The system could also significantly improve transparency and documentation of MDT decisions and increase the rate of accrual into research trials. To test this hypothesis, we are running a randomised controlled trial in the Royal Free Hospital.